Briefly Noted April 2018

March 29, 2018

The window of time between a stroke and effective thrombectomy may be as long as 16 hours in many cases, according to a study in the New England Journal of Medicine. But advanced brain imaging technology may give physicians an extra 10 hours or more to respond to treat some strokes. A study published just three weeks prior put the outer limit at 24 hours for some stroke victims. The trial was terminated early for efficacy after 182 patients had undergone randomization, with 92 to the endovascular-therapy group and 90 to the medical-therapy group in the 38 centers where the study was conducted. The American Association of Neurological Surgeons, the Congress of Neurological Surgeons, and the Society for Academic Emergency Medicine endorsed new guidelines in January for the management of acute stroke. The guidelines include selection criteria for patients to receive mechanical endovascular thrombectomy up to 24 hours after a stroke.

Revisions to the suggested timetable of adult pneumococcal vaccination in 2012, 2014, and 2015 have caused some confusion among primary care physicians about when patients should receive the vaccine, according to a study in the Journal of the American Board of Family Medicine. “Almost all surveyed physicians reported recommending both pneumococcal vaccines, but a disconnect seems to exist between perceived clarity and knowledge of the recommendations,” the study states. “Optimal implementation of these recommendations will require addressing knowledge gaps and reported barriers”.

A survey of 500 employees in the U.S. and Canada found that 82% participate in at least one wellness program, according to a story in HR Technologist. In addition, 64% said that their company does a good or excellent job getting workers excited about wellness programs. Not all is rosy, however. The LifeWorks survey finds that one in three employees believe that their company needs to do a better job in drumming up excitement.

In an effort not to get stuck with patient bills, some hospitals are teaming up with financial institutions in order to offer patients—sometimes when they are still on gurneys—loans to help pay for expenses. It’s controversial. Kaiser Health News reports that “promoting bank loans at hospitals and, particularly, emergency rooms raises concerns, experts say. For one thing, the cost estimates provided—likely based on a hospital’s list price—may be far higher than the negotiated rate ultimately paid by most insurers”.

A little bit can go a long way when it comes to physical activity. According to a study in the British Journal of Sports Medicine (and as reported in Medical News Today). Just several minutes of low-intensity physical activity may significantly reduce mortality risk among elderly men.

EHR data more accurately measures the quality of care for veterans with TIAs than traditional chart reviews, according to a study in Circulation: Cardiovascular Quality and Outcomes. Veterans Affairs researchers used EHR data to develop 31 electronic quality measures to evaluate the care of TIA patients.

More than 8% of adults 20 and older suffer from depression, according to a CDC report. The NCHS Data Brief says that 80% of adults with depression report problems with work, home, and social activities. As was found in previous studies, depression “was almost twice as common among women (10.4%) as among men (5.5%).

The Milwaukee District Attorney’s Office slapped Miami-based Armor Correctional Health Services with seven misdemeanor counts of intentionally falsifying records in a case in which an inmate died of dehydration. Armor is the vendor that supplies health services to the jail. The charges say that 38-year-old Terrill Thomas was denied water as a punishment for seven days in April 2016. Three jail employees have also been charged.

Sudden unexpected infant deaths in the U.S. dropped from 154.6 per 100,000 live births in 1990 to 92.4 per 100,000 in 2015, according to a study published in Pediatrics. But the decline has plateaued lately: There was a 44.6% drop from 1990 to 1998, but only a 7% decrease from 1999 to 2015.

Sitting is bad for you. Corporate Wellness Magazine lays out just how bad. “Within a couple of hours of sitting, your metabolism drops about 30% lower than walking. Plus, your good cholesterol plummets about 20%.” The magazine also outlines some ways companies are combating the problem. It cites a three-year study of 6,200 employees that found that “nonadjustable workstations had 20 times the workers’ compensation costs compared to user-adjustable workstations”.

Medicare payments to 751 hospitals were lowered as a penalty for them having the highest rates of patient injury, Kaiser Health News reports. The penalties fell heavily on teaching hospitals. As the Kaiser news service notes, the penalties have been controversial. The hospital industry says they unfairly punish hospitals that treat sicker patients and those that do a better job of identifying infections and other patient complications. Quality and patient advocates say that they have nudged hospital executives toward improving care.

VA facilities participating in the VA Choice program must meet certain standards to qualify as preferred treatment centers under a change in Senate legislation approved February 21, reports Modern Healthcare. “The proposed reforms would significantly expand the private sector’s role in VA health care,” according to the report. The change pits Veterans Affairs Secretary David Shulkin, MD, against Concerned Veterans for America, a not-for-profit group funded by conservative mega-donors Charles and David Koch, reports the magazine.... Physicians want to see proof that digital health care technology can actually improve patient care before they adopt that technology, according to a report by the AMA and Partners HealthCare Center for Connected Health. The other three main questions physicians have about new technology are: Will I get paid? Will I get sued? Will it work in my practice?